FORM-6 GY cemenyecoodrnsiintsonniany SME % G ELECTION COMMISSION OF INDIA s Se edb Application Form for New Voters AI , ‘The Electoral Rejtation Ofer, No.8 Name of AsebyConstivency No, (Fi. 8 Nae of Parmenter Conse No, (€0ny or Union Terie not ang Legit Asem) i | submit ppleation forincuson of myname nthe elt rl forthe ebove onstiveny. Name Sharpton) Name. (ifa)Nare rofl ngueot sa Fete eens Ms Nae PeNrO suman fa) BSGy0 (1)0.) Name (In English in BLOCK LETTERS) First Name followed by Mile Name SAIRAM ‘Suma ay) DEVARUPPULA Dislame frame no file innit be tantra y ota (22) Name and sumare fc languageof Ste) any one of he rtis: fates [7] or water [~] or tustand [] or we) or egal Guten incase of orphan Thr Gender (2) Name and surare (n Eglsh in LOCK LETTERS) the eltie mentioned above YADAGIRI DEVARUPPULA frend dH} (9) Mobie oof Se fava) feat mestnedat tem Wo, 2 (4) ers of St axabi) evarupulasaiamagmalicon o frat mntonedattem Ne, 2 (6 ashes betas (6) ender ((e)ome ofa adore) (b) sefatested copy of documertsupotng ge pot tached anyone ote folowing) (Docu for Prot of Date of Birth (Ay one of hese) lit cerifeate isvedby Competent Local Boy/unipalAutorty/Reitar of its & Deas 2 pacha ard af] PaNears af] Ding iense 5.) Catia fase Xr Cas Xlissued by CBSE CSE Stat Educa icon Date of Bt ef) edn Passport (Ary Ober Dosurent for Prof of ete of ith (re dosent isavaebe) Speci)(We reser Orday Residence Fades) House/uldingApwrtmentNo, 2-76 276 SteetvearLocaly, BLOOK2 375-2 Tesauga Mandl DHARMASAGAR S206 Tonite NARAYANAGIRI POMC Post ice NARAYANAGIR PO aPenca 8 oF Ske)UT Telangana District Hanumakond Pincade 506142 (b) Seats copy of ais prot eter nthe nae of eppicat or en nef pares! spouses chi i aes eld as ctr at tesa adress (tach anyone of hen) (Docurent or poo of residence 1 ate ketty/oas conection lor tat adess(teast 1 yee) a | pacaercat |) camer passbook of Natealized Scheduled Bank Post Ofice 4] tndanassprt Sani pes a nnn ekki a 6) pei esse eco) 71] _ Reiter see Deeincas of om house) any he bocuent for Poof resdece (fn documents ealabe) Speci) (@jategry of sbi. any (Opto) Locomatie vin! [ Dest ayo sept) Perentage of dsabiy "cerca atiached (Tk the ppopriat box) Yes | No ] (10)TR deta of my ay mere eat nuded nthe electoral at cuentas wth who cure reser asunder are o family member DEVARUPPULAYADAGIR Felatonship wih apis Father Fisher EPICro, RMOTESTE DECLARATION: - ‘HEREBY DECLARE that othe best of my knowledge anblel- (Dam citizen of nde and place of my births Ton Vilage NARAYANAGIRI Distt: Hanumakonda State(UT Telangana (Jamon resident tthe sess mentioned at No (a Frm 6 since: 202-01 (i amappyieg fonction nlc Rel fo thes time ae my rame tine in any Assembly Constuency/ Parliamentary Cnsttuency. (ho) do possess ay of the documents of age poo. Therefore Ihave enclose: (Name he document in supporto age rool (Ske of tapi) (0) amare tat making theabore statement or dclation nln tots applstin whichis fle and wl know or elev to be aso o not eve tobe tu, i purihabe under ‘Section 3 of Represertatin of the People At, 19504 of 1980) th imprisnmert for aterm which may extend to one year wth fine cr ith both DATE 10-09-2028 PLACE:NARAYANAGIRI AccesibityInstuctons In theight of provisions of Rights of Persons with isablties Act 2016 and Rights of Person wih Dsbltis Rules, 2017, incase of persons wthintlectal Asabily, ‘ats, cerebral pals and mute csbitis et, signature orf hand thm meesinof person with csbily, or sigratureo left and thumb impression of ise leg quran willbe required. ate: | nase ofa mare female applicant ame of Husband may preferably be mentioned 7 | Susin of el atested copy of ocarent wil encire speedy delver of series. 4 |Incasenone ofthe documents save el verfeatons must As for example, category Ike homeless nan zens who are terse elgleo become electors but dont possess ey documentary prot of ordinary sien, letra Registration fcr shal designate an fer fr eld veiestion. Aciomsipemet Rect nwledgerert Number $2908806N609251200087 are ve052008 eceiveahe appcatn in Fam 6 of SriSMS ARAM DEVARUPPULA Brower S630 appent can fre Actnonledgeent Noto check the sats of epaton] “This Is @ computer geerted document and does not require signature **